HMSA jobs

Lead provider performance management activities. Monitor technical, process, and business outcome metrics across all provider contract requirements and Service Level Agreements (SLAs). Recommend actions for improvement and drive continuous improvement. Oversee and manage staff. Manage the performance governance aspects of provider services contracts. These activities include: Enforce compliance with the contractual SLAs and deliverables. Review and validate performance reporting. Capture potential value leakage and/or service level penalties. Coordinate implementation of SLA reporting automation. Generate dashboards and reports for executive level briefing. Develop and measure provider network performance metrics and objectives, such as: Cost, quality, and accessibility reporting. Network reporting supportive of open enrollment and RFP's. Ensure all regulatory network requirements are measured and reported according to listed requirements, such as: ACA, QUEST, Medicare, HMSA Oversee data analysis functions that support contract negotiations and fee reviews. Oversee out of network provider access strategies including: Single case agreements Network access partner solutions Perform all other miscellaneous responsibilities and duties as assigned or directed. #LI-Hybrid

* Data Governance Expertise and Processes * The Data Governance Analyst will coordinate and contribute to the management of governance processes, including reviewing existing processes and assisting in the implementation of new ones aligned with corporate priorities and initiatives. This includes: * Utilizing and supporting data governance and analytical tools to evaluate data quality, applications, and workflow functions. * Informing workflows for data governance, data quality, data catalog, master data, reference data, and data lifecycle management. * Identifying and proposing efficiencies to streamline and transform data governance processes. * Collaborating with Information Services to help establish standards and capture appropriate metadata in informatics for all data assets on an ongoing basis. * Reviewing new data assets and applying governance principles to determine optimal integration into the governance environment. * Stakeholders, Project, and Service Requests * Provide support and coordinate stakeholder interactions, projects, and service requests across the enterprise. * Develop relationships with business and technical stakeholders, identifying opportunities to apply governance principles and enhance collaboration. * Collaborate with business and technical teams during project delivery. * Manage incoming data governance requests by triaging, assigning, and monitoring their execution and delivery. * Analyze and resolve data governance--related issues with moderate oversight. * Perform ad-hoc data and process analysis as needed. * Data Governance Office Support * Learn current data governance trends and best practice. * Actively support the team as a knowledgeable resource in data governance and data management. * Performs all other miscellaneous responsibilities and duties as assigned or directed. * Collaborates with colleagues across departments to accomplish both individual and team responsibilities. #LI-Hybrid * Bachelor's degree and three years of experience in the healthcare industry or data management/data governance roles; or equivalent combination of education and experience. * Strong customer service and planning skills, with proven ability to work independently on routine tasks. * Demonstrated intermediate problem-solving and analytical skills in data governance contexts. * Working knowledge of master data, data quality, and data catalog functions, with an understanding of data architectures. * Ability to communicate clearly with both technical and non-technical stakeholders, tailoring messages appropriately. * Intermediate experience in data analysis, SQL query construction, and familiarity with data governance, ETL processes, and database principles. * Practical, hands-on experience with Informatica Cloud Data Governance & Catalog (CDGC) and Informatica MDM SaaS or similar tools (e.g., Collibra, Alation, Talend) in a governance context. * Intermediate working knowledge in Microsoft Office applications, including but not limited to Word, Excel, Outlook, and PowerPoint.

* Lead as an IO Audit and Control Subject Matter Expert (SME) on process and controls. Review and monitor design of IO controls department-wide with the purpose of identifying ineffective or inefficient processes and advising on corrective and/or preventive course of action. * Execute and manage compliance due diligence activities (e.g., management testing of controls, process walk-throughs, 3rd party technology risk assessments, contract reviews, etc.). Serve as the liaison between the IO team, internal/external auditors, and other 3rd parties within the compliance, audit and risk management process. * With limited direction and input from IO leadership, develop and execute an IO audit support plan. * Communicate within the IO organization as well as with external partners to develop an overall understanding of compliance requirements and make recommendations on strategy/process as it relates to compliance practices. * Receive and evaluate audit issues raised by HMSA Internal Audit and external audit teams. Work with appropriate IO units on analyzing and reporting root cause, corrective actions, and formulating responses to management. * Document and report status of agreed upon remediation plans, owners and commitment dates. * Develop and maintain an in-depth understanding of industry compliance management trends and risks within technology markets. Maintain keen awareness of external and internal business initiatives, trends, issues and policies which may affect IO and provide input to IO management on audit and controls considerations. * Performs all other miscellaneous responsibilities and duties as assigned or directed #LI-Hybrid * Bachelor's degree and seven years of related work experience; or equivalent combination of education and related work experience. * Expert experience developing and presenting actionable solutions to complex problems with C-Suite level. * Effective written and verbal communication skill, including the ability to communicate and present complex issues in a concise and easy to understand manner. * Able to support and drive process improvement. * Able to drive increased operational quality. * * Intermediate knowledge of Microsoft Office applications including, but not limited to Word, Powerpoint, Outlook and Excel.

* Provide strategic management and direction for the configuration of health plan products, provider networks, and reimbursement methodologies to ensure alignment with business requirements, state and federal regulations, and accreditation standards. * Develop and implement policies, standards, and governance frameworks for configuration accuracy, quality control, and compliance. * Collaborate with external partners, IT, Claims Operations, Provider Services, Compliance, and Product teams to ensure system configurations support new products, regulatory changes, and organizational initiatives. * Lead testing, validation, and sign-off processes for new configurations, system upgrades, and change requests * Drive process improvements and automation opportunities to enhance configuration efficiency and reduce errors. * Serve as a subject matter expert (SME) for configuration management, providing training, guidance, and mentorship to internal and external team members and business stakeholders. * Performs all other miscellaneous responsibilities and duties as assigned or directed. * Bachelor's degree and five years of related work experience; or equivalent combination of education and related work experience. * Five years of management/supervisory experience. * In-depth knowledge of managed care, PPO, HMO, Medicaid, Medicare Advantage, and commercial group health plans * Strong working knowledge of claims adjudication systems (e.g., Facets, QNXT, Epic Tapestry, HealthEdge) * Effective written and verbal communication skills * Intermediate knowledge of Microsoft Office applications including, but not limited to Word, Powerpoint, Outlook and Excel.

* Utilize medical necessity criteria from established medical policies and clinical practice guidelines to render precertification determinations as described in the Medical Management UM work plan. This detailed clinical judgment includes evaluating whether the requested service is a covered benefit under the member's health plan, is medically appropriate for the member's clinical condition or whether the request requires referral to a Medical Director for potential denial of the request. The Nurse Reviewer must follow each line of business' requirements and each accrediting body's (CMS, NCQA, HSAG) requirements for each request. Assists on inquiries from external parties such as the State Insurance Commissioner and from the Legal Department. Responsibilities include, but are not limited to: * Demonstrate understanding and application of over 250 Guide to Benefits, Evidence of Coverage, Plan Brochure, and Member Handbook. HMSA annually updated medical and drug policies, medical protocols, National Comprehensive Cancer Network, Milliman Care Guidelines, Drugdex, etc. to determine the medical necessity of urgent and non-urgent precertification requests. Urgent requests must be completed within 72 hours and non-urgent requests within 15 calendar days. * Use clinical judgment, medical necessity guidelines and plan benefits to determine approval, potential denial or alternative treatment of each urgent or non-urgent precertification request. Settings include inpatient, outpatient, in-state, out-of state and out-of country. * Document clinical case summary and review outcome of each review appropriately to meet regulatory and program requirements. * Review various types of services, including but not limited to: * Transplants * Air Ambulance * Chemotherapy * Clinical trials * Genetic testing * Cancer treatments/radiation therapy * Experimental/Investigational Services/Devices * New Technology * Utilize medical necessity criteria from established medical policies and clinical practice guidelines to render precertification determinations as described in the Medical Management UM work plan. This detailed clinical judgment includes evaluating whether the requested service is a covered benefit under the member's health plan, is medically appropriate for the member's clinical condition or whether the request requires referral to a Medical Director for potential denial of the request. The Nurse Reviewer must follow each line of business' requirements and each accrediting body's (CMS, NCQA, HSAG) requirements for each request. Assists on inquiries from external parties such as the State Insurance Commissioner and from the Legal Department. Responsibilities include, but are not limited to: * Call providers when additional clinical information is required to clarify or complete a complex precertification determination. * Approve precertification requests based on clinical judgment using criteria, medical record documentation and other information received from the provider. * Consult with Medical Directors on requests which do not meet clinical criteria and offer alternative covered health care options as appropriate. * Consult Medical Directors on potential quality issues identified during review of medical records. Refer cases to Integrated Health Management, Pharmacy Department or Benefits Integrity Department depending on the concern. * Evaluate suspended claims against medical records to determine the medical necessity and appropriateness of medical services, identify irregularities such as over or under-utilization of services, potential up-coding, over billing, etc. * Communicate timely, accurate information either verbally, electronically or in writing using clinical judgment, knowledge of medical/reimbursement policies and plan benefits to providers, members as well as internal MM staff and other internal departments (Claims Administration, Customer Relations, Provider Contracting, etc.). For denied services, ensure the denial, benefit and appeal language are accurate and consistent with department procedures, accreditation and regulatory guidelines. * Identify and refer members with specific medical and/or behavioral health needs or complex case management and collaborate with medical and behavioral case management staff. Identify and refer quality of care issues and suspected fraud, waste or abuse to the appropriate departments. * Perform pre-screening assessment of incoming pre-certification requests to ensure appropriateness of review. Advises non-clinical staff on clinical and coding questions to ensure correct system processes and entries. * Performs all other miscellaneous responsibilities and duties as assigned or directed. #LI-Hybrid * Associates degree in Nursing. * Current, unrestricted Nursing License in the state of Hawaii as an RN or LPN. * Two years clinical, case management or utilization management related experience. * Knowledge of current standards of care to be followed for a given diagnosis and the normative values of medical tests and procedures. * Strong organizational skills * Good communication skills both verbally and written * Analytical skills * Basic knowledge of Microsoft Office applications. Including but not limited to Word, Excel, and Outlook. * Currently licensed in Hawaii as an RN or LPN * (if applicable upon hire, proof of licensure to be provided by employee or confirmed by Human Resources)

* Design and lead execution of strategic plans to streamline operations, reduce claim turnaround time, meet accuracy requirements and improve first-pass adjudication rates. * Ensure all claims are processed in accordance with member benefits, provider contracts, regulatory requirements, and internal policies. * Drive operational quality programs, ensure we are adhering to industry standards and best practices, and support internal and external audits. * Partner with IT department and external service providers to enhance claims platforms and integrate automation, AI, and data analytics tools where applicable. * Ensure cost containment through fraud prevention, coordination of benefits (COB), subrogation, and provider contract enforcement. * Encourage a culture of continuous improvement, from the proper documentation of current state processes to proposing new solutions consistent with the future state. * Work with production leadership and business areas to develop relevant, timely, and effective training related to organizational changes and quality issues. * Performs all other miscellaneous responsibilities and duties as assigned or directed. * Support relationship(s) with service providers as applicable. #LI-Hybrid * Bachelor's degree and seven years of related work experience; or equivalent combination of education and related work experience. * Five years of management/supervisory experience * Expert experience developing and presenting actionable solutions to complex problems with C-Suite level. * Effective written and verbal communication skill, including the ability to communicate and present complex issues in a concise and easy to understand manner. * In-depth knowledge of managed care, PPO, HMO, Medicaid, Medicare Advantage, and commercial group health plans * Strong working knowledge of claims adjudication systems (e.g., Facets, QNXT, Epic Tapestry, HealthEdge). * Expert knowledge of business and management principles involved in strategic planning, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources. * Intermediate knowledge of Microsoft Office applications including, but not limited to Word, Powerpoint, Outlook and Excel.

Leads team to execute on key corporate/enterprise-wide initiatives. Support Program Managers to lead the planning, execution, and delivery of high-impact programs, ensuring alignment with organizational objectives and stakeholder expectations. Ensure team works collaboratively with program leads to assure program results are achieved, is delivered timely, within budget, and in alignment with enterprise goals. Select, develop, manage and mentor a team of program managers, coordinators, and consultants, fostering a collaborative and high-performance work environment. Establish and maintain best practices for program management and execution across the enterprise. Drive continuous improvement by analyzing program performance and implementing lessons learned. Coordinate resource allocation and manage budgets, schedules, and deliverables across multiple projects and initiatives. Ensure effective execution. Prepare and present program updates, reports, and metrics to executive leadership and other key stakeholders. Manage committees, and subgroups to fulfill program requirements. Monitor program progress, manage risks, and resolve issues to ensure timely and successful completion. Identify and actively resolve issues that hinder program efficiencies. Facilitate prioritization and planning with senior level executives and other key leaders (in collaboration with Corporate Development team) Applies project management principles to ensure the successful delivery of program objectives. Oversees scope management for requirements baseline, changes, and conflicts. Identifies issues, risks, and support change management for successful execution. Oversees scheduling, including delivery and maintenance of project plans. Oversees costs/budget management. Creates and fosters working relationships with internal and external parties that facilitate strategic success. Effectively conduct meetings and discussions to achieve consensus and to identify actionable tasks. Achieve service commitments from core and support functional areas. Prioritize, track and manage program deliverables. Ensure program documentation and reporting are complete and meets compliance requirements. Performs all other miscellaneous responsibilities and duties as assigned or directed to include.

* Prioritizes approved invoices and check requests according to payment terms. Assist with month-end accruals as needed. * Familiarizes with company policies and navigating steps in Dynamics GP, Certify and CentreSuite. * Verifies approver's level of authority to ensure that the cost center and the amount being charged are authorized. * Validates vendor id to ensure that the appropriate vendor and payment method are populated on the smart connect template for upload and posting. * Verifies completed smart connect data against approved invoices and check requests for accuracy. * Audits work of peers, provides guidance and assists with crosstraining of tasks with peers. * Processes more complex, exception situations involving vendor invoices, check requests and employee expense reports. Reconciles more complex vendor accounts and resolves vendor issues timely. Recognizes potential problem situations and escalates to management as needed. Assists with testing of new function. Transforms certain processes/procedures to improve efficiency. * Researches inquiries including more complex and sensitive inquiries for management, other departments and vendors. * Provides Accounts Payable related special projects support to management. * Balances Dynamics A/P system reports and be able to reconcile all special and A/P balance sheet accounts. Creates and updates vendors according to the approved invoices, check requests, supporting documents and complies with the IRS requirements. Assists with TIN matching, verbal confirmation of ach instructions and recording of journal entries timely and accurately. * Assists with check printing, check log, email remittance and upload to Documentum. * Performs all other miscellaneous responsibilities and duties as assigned or directed #LI-Hybrid * High school or GED and 18 months of related work experience; or equivalent combination of education and work experience. * Effective verbal and written communication skills * 10 key by touch * Basic working knowledge of Microsoft Office applications including Word, Excel, PowerPoint, and Outlook.

* Responsible for leading the support of HMSA's unified communications infrastructure. Responsibilities include, but are not limited to the following: * Ensures the reliability of HMSA's unified communications infrastructure, to include the planning and implementation of enhancements. * Implements, maintains and upgrades HMSA's unified communications infrastructure. * Updates configuration management tools. Documents procedures and configurations. * Administers the unified communications environment, to include the setup, deployment, and maintenance of component systems. Liaises with business units to develop and maintain an understanding of call center operations and requirements. Coordinates with business units to test and implement enhancements to unified communications components such as call center infrastructure. * Provides technical expertise across business functions, and understands the relationship between the business and the Information Systems Department. Explains infrastructure capabilities. Consults with other Information Systems Department teams regarding infrastructure requirements and provides recommendations for both the design and implementation of systems integration activities. Reviews and makes recommendations with respect to IT infrastructure that deviates from established architecture standards. Leads project planning and requirements gathering efforts. Recommends and creates action plans for systems development and / or integration. Identifies the need for major support contracts. Reviews vendor proposals. Prioritizes, plans and implements upgrades and ensure that change management procedures are implemented and followed. Prioritizes, plans and implements infrastructure repairs and installations. Coordinates and plans activities with vendors. Ensures that asset and Oversees the conduct of disposal procedures are adhered to. Designs and implements infrastructure replacement plans. Maintains inventories as appropriate. Monitors Key Performance Indicators and maintains service levels to ensure that requirements are met or exceeded. Escalates problems as required. Informs management as appropriate. * Troubleshoots and diagnoses complex and escalated problems. Works with multiple vendors to coordinate the resolution of issues. Reviews logs and maintains Information Technology Service Management tools to document changes and identify recurring problems. Identifies the training needs of users. Shares knowledge with users and other Information Systems Department staff. Updates users on the status of incidents and problems. Ensures that follow-up procedures are adhered to. Tracks customer satisfaction. Participates in long-term infrastructure strategy and planning. Participates in rotating on-call support schedules. Provides after-hours support to business operations, as needed. Supports remote locations across the Hawaiian Islands, to include overnight travel, as needed. Mentors and assists in the professional development of less experienced staff. Required to be on-call for critical incidents as they arise. * Employee must participate in continuing education and training as needed or assigned. This is to ensure an accurate and updated knowledge base. * Performs all other miscellaneous responsibilities and duties as assigned or directed. #LI-Hybrid * Bachelors degree or technical institute degree / certificate or equivalent work experience. * Five years of relevant information technology work experience. * Substitutions such as a higher-level degree, specialized training or certification and less work experience will be considered. * Demonstrates a high level of expertise in multiple of the following technologies; Cisco telecommunications infrastructure, call center operations / reporting, scripting, and collaboration tools to include telephony, e-mail, chat, presence, conference room infrastructure, and collaborative meeting infrastructure. * Strong written and verbal communication skills * Excellent interpersonal, problem-solving, and organizational skills * Strong planning, organization, and time management skills * Ability to solve practical problems and deal with a variety of unique situations where only limited standardization exists. * Basic knowledge of Microsoft Office applications. Including but not limited to Word, Excel, PowerPoint, and Outlook. * AWS Cloud experience including Amazon Connect, Chime and Lex is highly preferred.

* Revise and/or develop medical policies adopted from the BCBSA in conjunction with assigned medical director and in accordance with Development and Approval of Medical Policy administrative policy; process includes appropriate and timely implementation and publication. * Assist with activities related to the revision and/or development of medical policies, code reviews, and TEC topic research, which include Service Now ticket submissions and Workfront ticket requests (tickets include data requests and medical policy page updates). * Assist with the revision and update of MM C&S Unit assigned PRC pages. Collaborate with HMSA Communications Department with the accuracy of PRC page content and in the submission Workfront requests. * Support MM sponsored meetings by preparing and distributing an agenda, minutes, and documents to be discussed, and taking minutes (meetings to include UMC, OMD, TEC, Policy Workgroup). * Research and respond to requests from internal departments/units requesting information on new technology (including research supporting TEC activities) and medical policies. * Performs all other miscellaneous responsibilities and duties as assigned or directed. #LI-Hybrid * Associate degree and one (1) year of related work experience; or equivalent combination of education and work experience. * Demonstrated oral and written communication skills. * Proven organizational and time-management skills. * Basic working knowledge of Microsoft Office applications, including but not limited to Word, Excel, Outlook, and PowerPoint.

Recommends competitive and sustainable pricing for products based on actuarial models and market trends Leads product updates, maintains competitiveness and addresses customer needs throughout the product lifecycle Develops and implements data quality control procedures for actuarial performance data Collaborates with stakeholders to define the product vision and roadmap for future development Manages relationships with third-party vendors for product development Champions new methods for data visualization to effectively display actuarial product advantages and benefits #LI-Hybrid

Resolve enrollment, eligibility and billing issues and inquiries timely and accurately from members, employer groups and third party administrators by phone, email and written correspondence by: Researching and collaborating with other units or departments to find a solution Accurately updating member records Contacting external partners who provide services for/to HMSA's members Providing member or group education on enrollment, billing (bill resentment) and bill payment Support unit in performing enrollment and billing reconciliations activities for purpose of identifying discrepancies and initiating accurate and timely correction/resolution of internal as well as external processing systems. Support unit in daily enrollment functions to include processing of enrollments, disenrollment's and maintenance for members. Perform quality assurance audits of customer inquiries and member updates within constrained timeframes. Based on patterns or risk assessment, recommend improvement opportunities to provide processing efficiency and increase customer satisfaction. These can include but are not limited to identifying processing or servicing issues that can be addressed by a system or a workflow solution Training and Development Performs all other miscellaneous responsibilities and duties as assigned or directed.

Leads the annual planning process including developing financial tools and analyses and working with functional area leaders in refining their respective budgets into useful management tools. Analyze, identify and track key expense drivers in departments and programs to improve financial planning, cash flow forecasting, and provide key financial insights. Establishes personal standards of performance within broad framework of policy and objectives set by senior management. Assist VP, FP&A and Controller in creating planning and analysis function for the Finance Organization. Partner and coordinate with department heads and program teams as their finance business partner to help drive the planning and reporting cycles to ensure alignment and consistency with company strategy. Assist VP and Controller with treasury functions, including cash reporting, investment management, and deal valuation work. Acts as prime consultant on significant tasks that affect the organizations long-term goals and objectives, addresses problem complexity taking calculated risks and coordination of decision making. Present and explain financial results in a concise and easy to understand manner to Executive Committee, Project Team Leads, and other senior leaders within organization. Prepares and presents analyses, forecasts, and recommendations to senior business and finance leaders that support and drive key business, strategic, and investment decisions. Partner with VP and Controller to develop dashboards and enhance financial reporting, planning and analytical processes and systems, driving dramatically improved fiscal visibility and accountability with budget managers and leadership. Works with analytics and provides financial modeling support for business development, product development, marketing, and business operations. Establishes monthly financial forecast and KPIs for company goals. Provides leadership and direction through managers and staff, manages performance and talent develop. Perform all other miscellaneous responsibilities and duties as assigned or directed. #LI-Hybrid

* Monitor and analyze regulatory/accreditation/business requirements to invoke recommendations for program and/or policy changes as appropriate for various lines of business. * Lead/coordinate activities, which include internal audits, quality assurance control, quality improvement, provider satisfaction and department policies and procedures, to meet and/or maintain regulatory/accreditation/line of business requirements. * Serve as a resource to internal and external staff regarding issues relating to administrative policies and procedures, medical policies, and researching and resolving problems. * Edit all documentation generated by unit e.g., QIAs, reports, executive summaries, presentation materials, workplans, evaluations, annual plans, policies and procedures, minutes, agendas, provide feedback, and develop/generate monitoring reports/tools. * Coordinate/schedule training opportunities and develop/present related reports and various documentation. * Coordinate, support and document various department activities to ensure deliverables are completed by due date. * Perform other duties (e.g., attend meetings) as assigned. #LI-Hybrid * Bachelor's Degree and two years of related work experience; or equivalent combination of education and related work experience. * Strong oral and written communication skills; * Excellent analytical, organizational and time-management skills. * Recognized leadership abilities. * Proficient in the use of all Microsoft Office applications and Internet searches.

Monitor the performance and address issues with any business partners or vendors that supports the Members Servicing Department. Build relationships with both internal and external customers to include members and employer groups to address issues and concerns and improve the customer experience. Recruit and retain effective teams through selection, development, compensation and motivation of personnel; develop talents necessary to achieve short- and long-term objectives through effective training, mentoring and coaching. Provides feedback and guidance, including timely completion of interim and annual performance reviews. Monitors overall workflow and prioritizes staff's work. Review financial information and adjust operational budgets to promote and demonstrate desired corporate financial stewardship and outcomes. Performs all other miscellaneous responsibilities and duties as assigned or directed. #LI-Hybrid

Independently process group and direct payments received from walk-in members and groups while providing all customers with an exceptional customer-focused and positive HMSA Center experience. Ensure that the experience meets the customer's needs and exceeds their expectations. Communicate and promote HMSA's brand message and commitment to service excellence. Effectively and independently analyze and research inquiries from customers (internal and external) relating to billing and payments processed by cashiers. Handle customer inquiries (internal and external) by responding to their needs quickly and efficiently. Requires broad understanding of HMSA's business, including the Hawaii Health Connector, HMSA online storefront, LRSP, QNXT, and ancillary systems. Provide quality service in line with HMSA's mission and vision. Assist in bill production for individual subscribers and groups, including cycle billing and demand billing. Performs reconciliations and audits to ensure the billing system, A/R system, and electronic bill presentment system are in balance. Independently resolves any identified variances. Process mailed-in group and direct payments from members and groups. Process rejected and unprocessed payments from Bank of Hawaii Lockbox. Process miscellaneous payments from other departments: Medicaid, Workshops, Administrative Services Only, Long Term Care, etc. Process medical refund checks (HMSA or other) mailed-in by members and providers. Process miscellaneous checks from Finance & Accounting units. Process member Automatic Dues Payment Set-up (DPS) and mailing notification letters. Process QNXT Unapplied Cash Payments. Balance and reconcile deposits, and record payments to various general ledger accounts. Review and conduct analyses to assist the department in maintaining an efficient delinquency and cancellation process for individual subscribers and groups. Includes monitoring delinquent subscribers and groups, generating and mailing delinquency and cancellation letters, and ensuring that cancelled accounts are reconciled accurately. Process routine enrollment and group or subscriber maintenance transactions submitted in the HMSA Centers. Processes returned checks, agent fee bills, and issues petty cash. Balance cash daily and replenish till monthly. Record expenses to proper operating expense general ledger account. Make corrections as needed. Performs all other miscellaneous responsibilities and duties as assigned or directed

Coordinates various projects as assigned. Develops system requirements, test plan, test scenarios, test cases, anticipated test results and objectives and acceptance criteria. Also, performs testing, communicates status/concerns to appropriate parties, documents testing results, develops policies and procedures, and implements policies and procedures into production. Monitors and reviews all new project reports to ensure accuracy. Prepares analysis of financial statements for HMSA and other related entities in an accurate and timely manner. This includes preparation, summarization, and maintenance of any source data in various subsystems of financial data. Assures that all reporting complies with GAAP and CAS standards. Analyzes and interprets these laws/regulations and implements procedures to ensure compliance. Coordinates data that is obtained from other F/A units and other HMSA departments. Performs complex analysis of financial data for both revenue and expenses for HMSA and all of its subsidiary/affiliate companies. Researches the nature and causes of variances and fluctuations in these accounts. Performs analysis independently with limited direction and supervision. Presents findings and recommendations to management. Performs various reconciliation of information from source data to reported amounts. Analyzes and summarizes accounting transactions related to various HMSA contracts/programs to ensure proper recordation into the general ledger for these programs. Communicate effectively with other departments to gather this information. Provides assistance and performs research for various external and internal audits. Performs all other miscellaneous responsibilities and duties as assigned or directed. #LI-Hybrid

Design and lead execution of strategic plans to streamline operations, reduce claim turnaround time, meet accuracy requirements and improve first-pass adjudication rates. Ensure all claims are processed in accordance with member benefits, provider contracts, regulatory requirements, and internal policies. Drive operational quality programs, ensure we are adhering to industry standards and best practices, and support internal and external audits. Partner with IT department and external service providers to enhance claims platforms and integrate automation, AI, and data analytics tools where applicable. Ensure cost containment through fraud prevention, coordination of benefits (COB), subrogation, and provider contract enforcement. Encourage a culture of continuous improvement, from the proper documentation of current state processes to proposing new solutions consistent with the future state. Work with production leadership and business areas to develop relevant, timely, and effective training related to organizational changes and quality issues. Performs all other miscellaneous responsibilities and duties as assigned or directed. Support relationship(s) with service providers as applicable. #LI-Hybrid

Stakeholder Support: Support product managers by eliciting stakeholder input, documenting product needs, and participating in discussions across the product lifecycle. Assist with stakeholder communications to clarify goals, document decisions, and follow up on action items. Learn to understand the vision, goals, and operational needs of business units. Solution Design: Assist in eliciting and translating business requirements into user stories, acceptance criteria, test cases and solution documentation. Coordinate across agile team members to ensure requirements are understood and tracked. Support efforts to validate that delivered solutions meet business needs. Collaboration and Coordination: Participate in agile ceremonies (daily stand-ups, sprint planning, retrospectives, etc.). Collaborate closely with product owners, developers, testers, and designers. Document decisions, coordinate follow-ups, and track work items using team tools. Drive and coordinate initiatives from intake, analysis, design, build, test, deployment and support by managing product scope, user stories, sprint dates, issues, risk and communications. Product Roadmap: Assist with the maintenance of product roadmaps and backlogs. Help prioritize user stories based on input from senior product managers and business stakeholders. Coordinate reviews and demos with stakeholders to align expectations. Enterprise Agile Support: Learn HMSA's agile and product management frameworks. Support process improvement initiatives by contributing feedback and identifying gaps in tools or workflows. Vendor Evaluation: Support the evaluation of third-party tools by compiling requirements and documentation. Assist with vendor communication tracking and documentation. Performance Outcomes: Support product managers in tracking key performance indicators (KPIs), preparing reports, and documenting results. #LI-Hybrid